Migraine and Headache Specialists - What's So Special?

by Teri Robert Patient Advocate

How many doctors did you see before your Migraines or headaches were accurately diagnosed? How many doctors did you see before you found effective treatment? Too many?

I was lucky when it came to diagnosis. There was a long history of Migraines and "sick headaches" in my family, and my wonderful pediatrician, Dr. Lantz, diagnosed me with "migraine headaches" at the age of six. As is the case with many Migraineurs, Dr. Lantz and, later, my family doctor were able to manage my Migraines fairly well for many years. There were periods of time when I needed more help than they could offer. Unfortunately, the "specialists" they sent me to -- ENT's, neurologists, and a psychiatrist -- were no help. I heard it all...

  • "Congratulations. You're an intellectual. You have Migraines."

  • "Have a baby. That might help."

  • "It's a woman thing. Learn to live with them."

So, you can imagine that when my Migraines went really out of control, I knew there was no help in my hometown. My family doctor sent me 90 miles to a "great" neurologist. He really was great, and his recommended treatment worked well for a few year. Too bad for me, when the treatment quit working, I discovered that my wonderful neurologist had retired. I tried another one in the same city 90 miles away. This one was supposed to be a "Migraine specialist." Not. She and her husband had a huge neurology practice and treated all kinds of neurological problems from MS to trauma to "Migraine headaches."

Desperate for help, I hit the Internet. Do you know what I discovered? Neurologists aren't necessarily Migraine specialists, BUT there ARE doctors who do specialize in the treatment of Migraine disease and other headache disorders. This was news to me, and I've been told that it's news to many people before they start reading our articles here.

Not infrequently, people ask what's so different about Migraine specialists. What's so special about them? To answer that question, allow me to list some qualities of a good Migraine and headache specialist. They are doctors who...

  • generally limit their practice to treating Migraine and other headache disorders only.

  • truly understand Migraine disease and other headache disorders.

  • have vastly more experience treating Migraines and headaches than other doctors.

  • read journals, papers, books, and other medical literature to keep up with developments in the field.

  • are members of organizations such as the American Headache Society or the National Headache Foundation and attend their conferences to participate in continuing medical education in the field.

  • network and share ideas and experiences with other Migraine and headache specialists.

  • aren't afraid to say, "I don't know," or "I don't know what to try next," then find someone who does.

  • listen to their patients.

  • work with their patients as treatment partners, making decisions WITH their patients, not FOR them.

  • are willing to consult with their patients' other doctors to coordinate treatment.

  • answer questions and explain things instead of just throwing a prescription at us.

  • realize that we can't control when a Migraine or headache will get out of control and need after-hours treatment and has a preset plan for their patients to receive after-hours treatment.

  • train their staff members to be caring, polite, and at least minimally knowledgeable.

Does everyone who has Migraine disease or another headache disorder need to see this kind of specialist? No. Probably the majority of people with these disorders will never need this type of specialist. But, since you're reading this, it's likely that you or someone you know is having problems with getting the proper diagnosis or appropriate treatment. People who have been properly diagnosed and treated usually don't go to the Internet to read articles such as this one or the others on this site. So, maybe it's time for you to consider a specialist.

Consider a Migraine and headache specialist if...

  • your doctor hasn't been able to give you a firm diagnosis.

  • you have reason to doubt your diagnosis, even if it's a "gut feeling."

  • your doctor doesn't seem to listen and take your concerns seriously.

  • your doctor never has time or just doesn't want to answer your questions.

  • your doctor doesn't seem to know what to do for you, but isn't consulting another doctor about it.

  • you've been working with your doctor for a reasonable length of time without making progress.

No, not everyone with Migraine or headaches needs to see a Migraine and headache specialist. Still, you should know that there are such specialists. Many people think (as I used to) that neurologists are all Migraine specialists. They're not. Unless, they've chosen a subspecialty, they're the GPs of all things neurological. That means they treat many, many conditions, making it unlikely that they have the time, knowledge, or ability to specialize in an of them.

Doctors finishing medical school now have an opportunity that's been available for only a few years. They can now complete a residency in headache and Migraine treatment. It's a neurology subspecialty residency. It doesn't make that doctor a specialist, but it certainly means that when they begin their medical practice, they'll have more headache and Migraine education and experience under their belts than other new doctors. This is a step in the right direction.

Unfortunately, there aren't enough specialists in this field, and their ranks are not increasing. Many young doctors consider research opportunities when choosing their specialty fields, and NIH funding for headache disorders research is so near nonexistent that it's a less attractive field to these doctors than many other fields.

The shortage of qualified specialists means that you may have to spend some time locating one. You may have to travel to one farther from home than you would like, and you may have to wait (perhaps for months) for an appointment. Still, if you're having problems getting an accurate diagnosis or finding the right treatment regimen, seeking care from a qualified Migraine and headache specialist is the best way to go.


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Teri Robert
Meet Our Writer
Teri Robert

Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation's Patient Partners Award and a Distinguished Service Award from the American Headache Society.